Wound Care

Wounds require careful irrigation with saline and povine iodine and debridement to remove saliva, teeth, dirt, oils, and necrotic tissue. Primary closure is possible in areas where cosmetic results are important, where the wounds are not deep and extensive, and in patients without immune compromise. Otherwise, most authorities recommend that wounds be treated open with packing and bulky dressings. Most authorities also recommend delaying tendon and nerve repair until after the threat of infection has been resolved. Primary surgical repair is indicated to repair structures critical for survival. Reimplantation by hand and plastic surgeons of amputated extremities or avulsed tissue such as the lips and nose have been attempted with mixed success (16-20).

Hand injuries are of special importance because of their extensive nerve, tendon, and vascular structures and the compartments they create. Wounds must be carefully and aggressively irrigated and antibiotics given to prevent or mitigate infection. Care may eventually involve hand surgeons, if available (16-20).